When should I ask my Dentist for a Referral?

The other day I was talking with a friend, and he told me, “I have a great dentist.  He does EVERYTHING – root canals, orthodontics, gum surgery, even wisdom teeth.”  I’ve heard comments like this before, and they make me realize that there is a misunderstanding among the public when it comes to dentistry, which does not exist in medicine.
No one would ever say “I have a great family doctor.  He does EVERYTHING – brain surgery, appendix removals, even liposuction.”  Most people understand – at least in medicine – that no one can be an expert at everything.  Family doctors have their areas of expertise, but what makes a family doctor truly great is in knowing when to refer you to a specialist to get the best possible care.  The same is true in dentistry.
Many people are unaware that specialties exist in dentistry.  Dental specialists are:
  • Orthodontists (experts in straightening teeth, correcting bites, aligning jaws)
  • Oral Surgeons (experts in removing teeth, surgery on the jaws)
  • Endodontists (experts in root canals)
  • Periodontists (experts in treating gum disease)
  • Pediatric Dentists (experts in treating children, patients with behavior problems)
  • Oral Radiologists and Pathologists (experts in diagnosing complex problems of the jaws)
These specialists are dentists who, after finishing dental school, completed another 2-4 years of additional training, specifically in managing their area of expertise.  Thus, an orthodontist has MUCH more training than a general dentist in using braces and Invisalign.  An oral surgeon has MUCH more training at removing wisdom teeth and performing surgery on the mouth.  And so, patients who require these procedures would be well-advised to seek a referral to a specialist.
So why don’t dentists automatically refer patients to specialists?  Well, many of them do exactly that.  But some dentists take continuing education courses, training to perform procedures previously only done by specialists.  And with their additional training, they don’t always see the need to refer patients elsewhere.  Or sometimes they know that a specialist will charge a higher fee for a given procedure, and they will offer to do the procedure themselves to save the patient money.  It becomes difficult, from the patient’s perspective, to know whether to ask for a referral or not in such cases.
To help with the decision making, here is a short (and by no means comprehensive) list of problems for which I would recommend that you seek a referral, no matter how much continuing education your dentist has done:
  • Extraction of impacted wisdom teeth (or any complicated extraction)  (Oral Surgeon)
  • Gum surgery, including grafts and crown lengthening (Periodontist)
  • Gum disease with 5mm or more of pocketing or recession (Periodontist)
  • Root canals of molars (Endodontist)
  • Bone grafting surgery prior to implants (Periodontist or Oral Surgeon)
  • Implant placement where more than 2 implants are to be done, or where the implants are not in the front of the mouth (Periodontist or Oral Surgeon)
  • Orthodontics of any kind, whether braces or Invisalign (Orthodontist)
Although there are general dentists who offer the above procedures in their offices, I think that in a city as well-served by specialists as Toronto, there is no good reason not to see the best-trained person for these highly complicated procedures.  Doing so will give you the best chance for an excellent result and the lowest chances of failure or complications.
You see, a dentist might pull wisdom teeth, but if something goes wrong during the procedure the patient will be sent to an oral surgeon who is trained to handle complications.  Would it not be wise to see that oral surgeon right from the start, knowing that the procedure is a complex one?
A dentist might be a certified Invisalign provider (all that takes is a single, 10 hour course), but if something goes wrong and the teeth or bite do not align, dentists often lack the training to correct the problem.  At that point, they will refer you to the orthodontist you could have seen to begin with, and perhaps avoided the problem altogether.
Dentists are your first line of defense against problems of the teeth and mouth.  They are an integral part of your health-care team, and are the people best suited to help you with cavities, mild-to-moderate gum disease, dealing with missing teeth, and handling esthetic concerns in your mouth.  But for patients with more complex problems of the mouth, seeking a referral to a specialist is just as advisable as seeking a referral to a medical specialist for any other part of your body.

What are the top trends in orthodontics for Adults today? Discreet.  Comfortable and Convenient.

Invisalign braces discreet
Orthodontics haven’t been just for teens or children for many many years.  It’s commonplace for adults to want treatment so that they can straighten their teeth, improve their smile and give them both aesthetics and confidence in their professional lives.  But adults have different needs when it comes to braces.  Often their daily lives are rather hectic and caring for traditional braces the same way a teenager would have to do is not always achievable with the various responsibilities they have.  This is why, while there are several options available to adults, Invisalign has become extremely popular with them.  Invisalign’s smile straightening system is extremely easy for adults to work with and has virtually zero impact on their busy lifestyles.
Patients, especially adults, expect their orthodontic options to be attractive, pain-free and easy to work with. It is precisely these kinds of demands in the marketplace that gave rise to the trends we see in Orthodontics prevalent today.  As such, the top three emerging trends in orthodontics, which drive many of the products and services available to patients  1) Discreet, 2) Comfortable and 3) Convenient
Find out how Invisalign is a market leading technology when it comes to these three orthodontic trends.
#1 — Braces have to be discreet.
Let’s face it, most adults don’t like the look of braces.  But what about if you could have invisible braces?  Invisalign doesn’t work like traditional braces which employ the use of brackets and wires to shift the teeth into position over time.  Instead, Invisalign aligners are virtually invisible (think of something like a clear mouthguard that snaps over your teeth).  The aligners are also removable and they fit snugly over your teeth, snapping into place.  As far as orthodontic solutions go, they are by far the most discreet and this reason above all else is why they are such a favourite with adult patients especially.
Trend #2 — Orthodontics have to be comfortable.
In the past, orthodontic treatment functioned with heavy forces moving teeth into place.  They were regarded as uncomfortable and something no one looked forward to going through.  That simply isn’t the case any longer.  Now you can have your teeth straightened with minimal concern for comfort as most if not all systems are designed to maximize your personal comfort.  Invisalign is by far one the most comfortable to work with.  The aligners themselves are smooth and made of a BPA free plastic that can in fact be removed for mealtimes, thus reducing both the daily maintenance required.   Not only are the aligners smooth, but they are extremely comfortable to wear, custom fit to your mouth for a very snug fit and making all aspects of hygiene a breeze.
Trend #3 — Orthodontic treatment has to be convenient.
Today’s patients need a convenient option.  No one has time for cumbersome solutions nor are they going to sacrifice their lifestyle and valuable time.  Invisalign as a concept is all about convenience. The simple fact that the aligners can be removed puts the system in a class all on it’s own.  Think about it, you can simply remove the aligners for those very special occasions, and then just snap them back in afterwards.  The system also necessitates the least amount of subsequent visits to the orthodontists office, giving you more time to address the many responsibilities of your busy day.
Discreet, Comfortable and Convenient.  These really do capture the essence of the Invisalign straightening system.   We would be remiss if we didn’t mention that the system is not appropriate for every situation though.  If you are interested in learning about whether you are a candidate for this option, contact our office and Dr. Kellerstein would be happy to sit down with you and go through all the various benefits and treatment options with you in person.